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Investigation Announcement: Multistate Outbreak of Human E. coli O145 Infections Linked to Shredded Romaine Lettuce from a Single Processing Facility
Updated May 6, 2010
Confirmed cases of E. coli O145 Infection, United States, by state
Infections with the outbreak strain of E. coli O145, by date of illness onset (n=19 for whom information was reported as of May 5, 2010)

Local and state public health officials in Michigan, New York, and Ohio are investigating human illnesses caused by E. coli O145. CDC is supporting these investigations and facilitating regular communication and information sharing between the states and with the U.S. Food and Drug Administration (FDA).
As of May 5, 2010, a total of 19 confirmed and 10 probable cases related to this outbreak have been reported from 3 states since March 1, 2010. The number of ill persons identified in each state with this strain is : MI (10 confirmed and 3 probable), NY (2 confirmed and 5 probable), and OH (7 confirmed and 2 probable).
Among the confirmed and probable cases with reported dates available, illnesses began between April 10, 2010 and April 26, 2010. Infected individuals range in age from 13 years old to 29 years old and the median age is 19 years. Sixty-nine percent of patients are male. Among the 29 patients with available information, 12 (41%) were hospitalized. Three patients have developed a type of kidney failure known as hemolytic-uremic syndrome, or HUS. No deaths have been reported.
The outbreak can be visually described with a chart showing the number of persons who became ill each day. This chart is called an epidemic curve or epi curve. Of note, it takes an average of 2 to 3 weeks from the time a person becomes ill to the time when the illness is confirmed by laboratory testing and reported. Please see the E. coli Outbreak Investigations: Timeline for Reporting Cases for more details.
The bacteria responsible for this outbreak are referred to as Shiga toxin-producing E. coli, or STEC. STECs have been associated with human illness, including bloody diarrhea and a potentially fatal kidney condition called hemolytic-uremic syndrome (HUS). STEC bacteria are grouped by serotypes (e.g., O157 or O145). The STEC serotype found most commonly in U.S. patients is E. coli O157. Other E. coli serotypes in the STEC group, including O145, are sometimes called ¡°non-O157 STECs.¡± Currently, there are limited public health surveillance data on the occurrence of non-O157 STECs, including E. coli O145, therefore E.coli O145 may go unreported. Because it is more difficult to identify than E. coli O157, many clinical laboratories do not test for non-O157 STEC infection.
Investigators are using pulsed-field gel electrophoresis (PFGE), a type of DNA fingerprint analysis of E. coli bacteria obtained through diagnostic testing to identify cases of illness that might be part of this outbreak. This testing is done in public health laboratories as part of the PulseNet network. Investigators have established a common definition of confirmed and probable cases related to this outbreak.
Confirmed cases are persons with:

(1) E. coli O145 infection, or E. coli infection with O Group pending, AND
(2) an illness onset on or after March 1, 2010, AND
(3) a DNA fingerprint matching the outbreak strain; AND
(4) an epidemiologic link to the outbreak.

Probable cases are persons with an epidemiologic link to the outbreak and

(1) E. coli O145 infection with an illness onset on or after March 1, 2010 regardless of DNA fingerprint pattern, AND/OR
(2) hemolytic-uremic syndrome; AND/OR
(3) a laboratory isolate positive for Shiga toxin 2 [stx2] or isolate positive for Shiga toxin, but toxin type is unknown or pending.

Current Status of the Investigation
Multiple lines of evidence have implicated shredded romaine lettuce from one processing facility as a source of infection in this outbreak. This evidence includes the identification of E. coli O145 from an unopened package of shredded romaine lettuce obtained from a facility associated with the outbreak. DNA testing to confirm the link to ill persons is pending at this time. The lettuce processing company has issued a recall of lettuce produced at their facility as a result of the evidence obtained to date.
This investigation is ongoing. At this time, local, state, and federal health officials are involved in many different types of investigative activities including:

Conducting surveillance for additional illnesses that could be related to the outbreak.
Conducting epidemiologic studies that includes gathering detailed information from persons who were ill persons (cases) and from healthy persons (controls) about foods recently eaten and other exposures.
Gathering and testing food products that are suspected as potential sources of infection to see if they are contaminated with bacteria.
Following any epidemiologic leads gathered from interviews with patients, food purchase information, or from patterns of processing, production and/or distribution of suspected products.
FDA is working closely with its state partners in the investigations at the food processor and at the farm level to determine where in the distribution chain the point of contamination likely occurred.
Public health and agriculture officials in Michigan, New York, and Ohio, along with CDC and FDA, are actively engaged in this investigation. Updates on the progress of this investigation will be shared as information becomes available.
Clinical Features/Signs and Symptoms
Most people infected with E. coli develop diarrhea (often bloody) and abdominal cramps 2-8 days (average of 3-4 days) after swallowing the organism, but some illnesses last longer and can be more severe. Infection is usually diagnosed by culture of a stool sample. Many clinical laboratories do not test for non-O157 STEC, such as E. coli O145, because identifying it is more difficult than for E. coli O157. Most people recover within a week, but some develop a severe infection. A type of kidney failure called hemolytic uremic syndrome (HUS) can begin as the diarrhea is improving; HUS can occur in people of any age but is most common in children under 5 years old and the elderly.

E. coli O145 lettuce outbreak: how many people sick?
Posted on May 6, 2010 by Drew Falkenstein

The E. coli O145 outbreak in Michigan, Ohio, and New York, which has long had a suspected lettuce link (and was publicly confirmed today), has no doubt sickened quite a few people. Just how many, however, is hard to know for sure. Some reports put the number as high as 60. Some say 47. Today, the FDA stated that there are 19 confirmed illnesses with ten more pending. Of the 19 confirmed illnesses, according to the FDA, 12 people were hospitalized and 3 developed hemolytic uremic syndrome (HUS).
The true scope of this outbreak, one of many in a long line of lettuce and leafy green e. coli outbreaks, will probably not be known for some time. One thing is for sure, however, about the number of people already affected by it. It is a bigger number than 19 (because the FDA/CDC will only count people who have a culture confirmed infection that is a genetic match to the outbreak strain); it is a bigger number than 29 (the number of confirmed illnesses, plus those that are pending); and its probably bigger than any other estimates to date as well.
Illnesses in foodpoisoning outbreaks are notoriously underreported. In fact, that is one problem that epidemiologists face in nearly any outbreak of foodborne disease (whether e. coli, salmonella, hepatitis, campylobacter, or anything else), and it sometimes frustrates their attempts to identify the actual cause of an outbreak.
There are any number of reasons why foodpoisoning cases go unreported, thus depriving investigating health authorities of the benefit of knowing what the ill person ate. The person did not see a doctor, or a stool sample was not done, or the sample returned a false negative result, or the person took antibiotics before submitting the sample.
But another reason why this particular outbreak may have caused many more illnesses than the numbers that are currently being stated is that the outbreak strain, E. coli O145, is frequently not tested for. Thus, even if an ill, infected person does have a stool sample tested, the sample may not return a positive result.
Discussing just this issue, the Center for Infectious Disease Reporting and Policy at the University of Minnesota (CIDRAP) issued a detailed statement today on the E. coli O145 lettuce outbreak linked to contaminated Freshway lettuce:
The CDC said there are limited surveillance data on illnesses involving non-O157 serotypes of Shiga toxin-producing E coli (STEC), including O145. "Therefore E coli O145 may go unreported. Because it is more difficult to identify than E. coli O157, many clinical laboratories do not test for non-O157 STEC infection," it said in the press release.
Craig Hedberg, PhD, a food safety expert at the University of Minnesota in Minneapolis, told CIDRAP News that the outbreak is similar to E coli O157:H7 outbreaks that have previously been linked to lettuce. E coli O145 has been associated with cattle, like O157 and other STEC strains. "And it seems likely that cattle would have been the reservoir source of contamination for this outbreak as well," he said. "Of course, since the production source has not been identified, this is all speculation on my part, but it seems likely."
One of the leading studies on the subject of underreporting suggests that the number of actual victims in a given outbreak, as opposed to merely those with positive stool samples, is as much as 38 times the number of stool sample confirmed individuals. If there are 29 confirmed (or pending confirmation) illnesses in this outbreak, the number of people actually sickened may be . . . a little scary. Time will tell.

Romaine Lettuce E. Coli Food Poisoning Link Confirmed by FDA and CDC

Published: May 11th, 2010 ?
Federal investigators have confirmed that 19 cases of E. coli food poisoning across the Midwest were caused by shredded romaine lettuce that was tainted, and say the source may be an Arizona grower.
The romaine lettuce food poisoning update was issued yesterday by FDA and the U.S. Centers for Disease Control and Prevention (CDC) in response to a Freshway Foods romaine lettuce recall issued last week. Officials said they have confirmed that the strain of E. coli O145 detected in an unopened bag of Freshway Foods shredded romaine lettuce is the same strain that has sickened 19, and hospitalized 12.
However, another romaine lettuce recall has been announced by Andrew Smith Co., in Spreckels, California, due contamination by what Ohio health officials say is a different strain E. coli O145 than that affecting the Freshway lettuce, meaning the two recalls currently appear to be unrelated.
Smith is recalling 1,000 cartons of romaine lettuce, totaling about 23,000 pounds, according to a story by the Columbia Dispatch. Like the Freshway Foods romaine lettuce recall announced last week, the lettuce was sold to restaurants and food service outlets; not directly to consumers.
No illnesses have been connected to the Andrew Smith romaine lettuce contamination, but the E. coli tainted Freshway Foods lettuce has caused illnesses in Michigan, Ohio and New York, FDA reports. There have been 19 confirmed E. coli food poisoning cases, and there are additional reported illnesses that have not been confirmed, but are suspected. Three of the 12 people hospitalized face potentially life-threatening complications from hemolytic uremic syndrome (HUS), which can cause kidney failure and brain damage.
The FDA update says that attempts to track the source of the E. coli contamination of Freshway Foods romaine lettuce have led to a farm in Yuma, Arizona, where the lettuce was harvested. Investigators have not yet confirmed that the farm is the source of the contamination, however. The discovery has caused a third company, Vaughan Foods of Moore, Oklahoma, to also recall some romaine lettuce distributed with ¡°use by¡± dates of May 9 and May 10, which was also sold only to restaurants and food service facilities.
The recall affects shredded romaine lettuce with a use by date of May 12 or earlier, which was sold under the Freshway Foods or Imperial Sysco labels to food service outlets, wholesalers, and in-store retail salad bars and delis. The lettuce was distributed throughout Alabama, Connecticut, District of Columbia, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, West Virginia, and Wisconsin.
Escherichia coli O145 is a bacterial strain that can cause diarrhea which is frequently bloody. While most healthy adults recover within a few weeks from E. coli poisoning, young children and the elderly could be at risk for more severe illness. If the toxin enters the blood stream, E. coli could also lead to HUS.

Fight Over Raw Milk "Buying Clubs" in Massachusetts
Posted on May 6, 2010 by David Babcock

Massachusetts is another battleground between advocates of raw-milk and those who point out its association to outbreaks of pathogens like E. coli O157:H7, Salmonella, and Campylobacter. Massachusetts officials have been making efforts to enforce a ban on the sale of raw milk outside of the producing farm:
The Boston Globe's Alex Beam writes:
It is legal in Massachusetts to buy raw milk at a farm but not in a store. However, the federal Food and Drug Administration and the state¡¯s Department of Public Health discourage raw milk consumption, because pasteurization removes potentially harmful bacteria, such as listeria and salmonella. A few years ago, a top FDA official likened drinking raw milk to ¡°playing Russian roulette with your health.¡¯¡¯
Massachusetts health officials explain that a majority of dairy related illness outbreaks are from raw milk, even though it is only a fraction of the dairy consumption:
¡°We don¡¯t want people to think this is a safe product to consume,¡¯¡¯ says Suzanne Condon, a DPH executive. ¡°Sixty-eight percent of all dairy-related, food-borne outbreaks relate to raw milk consumption.¡¯¡¯ Earlier this year, one of her subordinates sent a letter to the state Department of Agricultural Resources alerting it to the existence of ¡°buying clubs,¡¯¡¯ large groups of raw milkies who circumvented the buy-at-the-farm rule by arranging for deliveries to consumers who don¡¯t live near farms. The MDAR promptly sent cease-and-desist letters to four clubs, stirring up a hornet¡¯s nest.
As usual, raw milk advocates see conspiracy theories at work:
[advocates] detect the extended hoof of Big Moo: ¡°The conventional dairy industry may be feeling some of the effects of the growing popularity of raw milk as part of the demand for locally produced, unprocessed foods,¡¯¡¯ says Needham¡¯s David Gumpert, author of ¡°The Raw Milk Revolution: Behind America¡¯s Emerging Struggle Over Food Rights.¡¯¡¯
Maybe instead public health officials are hoping to avoid more people having stories to tell like these victims?

Lettuce E. coli O145 outbreak has a high hospitalization rate
Posted on May 7, 2010 by Drew Falkenstein

One defining feature of the E. coli O145 outbreak linked to Freshway lettuce is its apparently high hospitalization rate. Generally, non-O157 strains of E. coli cause foodpoisoning illnesses severe enough to require hospitalization in .295% of cases, and cause death in .083% of cases. See article by Mead et al. In the lettuce E. coli O145 outbreak, reports suggest that, of the 19 confirmed and 10 probable cases, 12 have been hospitalized. This is a hospitalization rate of about 41%.
There are clearly many more E. coli illnesses in New York, Ohio, and Michigan than the 19 that are currently recognized by the FDA and CDC. Jose Rodriguez, a health official with the City of Columbus, Ohio, has indicated that 15 people were sickened in the Columbus area, including seven confirmed cases of E. coli that are counted in the FDA and CDC's current case count. Of these 15 confirmed and probable illnesses, seven people were hospitalized, including five students at Ohio State. This is well over a 50% hospitalization rate among recognized cases in the Columbus area alone.
Another indicator of the virulence of a particular strain of E. coli is its association with hemolytic uremic syndrome (HUS). In the Freshway lettuce E. coli O145 outbreak, at least 3 of the 29 confirmed cases have developed HUS, which is a potentially life-threatening complication. It is estimated that, in the typical shiga-toxin producing E. coli outbreak, up to 10% of cases may develop HUS.

Almanza is going for the record
Source: (Safety) Fight
By: Richard Raymond
Well, the Administration got it right this time, and it is about time I might add.
Since the Administration change in January, 2009, the position of Administrator for the Food Safety and Inspection Service (FSIS) has been declared an open position and applicants were encouraged and welcomed. That had to leave Al Almanza feeling a little uncertain about his future, and also had to make it more than a little tough to push for new policies and/or regulations to further enhance food safety for meat, poultry and egg products. Until now, that is. USDA announced on May 6 that Secretary Vilsack has reappointed Almanza as FSIS Administrator, subject to the Office of Personnel Management approval.
Al will still lack the partnership of a political appointee with Senate confirmation, however, as the undersecretary position still remains open after 16 months, even though the President announced his intent to nominate Dr. Elisabeth Hagen over 3 months ago. This position must be filled soon to provide Al with the political cover the Administrator needs and to take some of the heat off him so he can effectively lead and administrate an Agency with 9,500 employees and a budget of over one billion dollars.
Almanza joined USDA/FSIS over 30 years ago, starting as a food inspector in a small slaughter plant in Texas in 1978. He worked thru the inspection ranks up to deputy DM and then district manager for the Dallas district.
We asked Al to take over as Administrator in July, 2007, and he willingly and quickly made the move to D.C. His field experience, leadership skills, common sense attitude, work ethic and his openness and honesty were critical to me as an undersecretary who sometimes had to rely on others for a better understanding of what was taking place in slaughter and processing facilities. And this skill set also gave him instant credibility with the secretary, industry, consumer advocates and, of course, FSIS employees.
The average tenure of the Administrator of FSIS is about 2 years and 2 months. To the best of my knowledge, only two administrators have remained beyond 3 years. Al Almanza will hit the 3 year mark this July and he obviously is intent on staying well beyond that mark. That is good for FSIS, the USDA and the USA. Now that he has been reappointed, and as soon as Dr. Hagen gets her confirmation, I think we can expect to see some proactive changes in food safety. They know each other well, they will be secure in their positions, and they will move forward as a team, building on each other's strengths. I am glad USDA made the right decision and allowed a dedicated career employee to remain in the administrator's position, thus putting the protection of the public's health above politics.
This is a very, very tough job. I think Al Almanza is the right man for the job. How about you?

May 10, 2010

Is Free-Range Meat Making Us Sick?
May 10 2010, 9:10 AM ET |
About this time last year, I published a controversial article in the New York Times suggesting that free-range pigs had a higher risk of contracting trichinosis than confined pigs. My primary source was a peer-reviewed article that had received funding from the National Pork Board. Because the study had been published in a widely respected academic journal, I chose not to mention the funding source. My intuitive sense was that highlighting the industry connection would immediately prevent skeptics from reading further.
Big mistake. The food world pounced, the Times printed a shaming "editor's note," and I spent much of 2009 contemplating moving to West Texas and living in an underground house.
Lost in all the huffing and puffing over my omission, however, was the gist of the underlying question itself: to what extent are animals raised under free-range conditions prone to contracting diseases that can affect humans? Please understand that the point of exploring this question is not to promote the highly charged thesis that factory-farmed animals are better. Instead, the only goal here is to raise awareness about a method of farming animals that has?primarily on account of its status as a preferred alternative to concentrated animal feed operations (CAFOs)?escaped the critical scrutiny we've so dutifully applied to factory farms. The claim that free-range meat is a healthier option is a commonly heard bit of culinary wisdom. For anyone who eats meat, some hard scrutiny should be welcomed.
Since writing my disastrous Times piece, I've come across considerable research?none of it undertaken with corporate funding?that provides a wealth of information to help us assess the relationship between free-range animal farming and disease. In a study exploring rates of Trichinella and Toxoplasma in pigs raised in the Netherlands, several Dutch microbiologists found that their evidence "indicates that the prevalence of parasitic infections is higher in outdoor farming systems than in indoor farming systems." An investigation of a Trichinella outbreak in Sardinia (which was long considered free of the disease) observed that the "parasite is restricted to free range pigs." In Switzerland, a study of free-range pigs and Trichinelli defined "free ranging pigs" as "the group with the highest risk of exposure." (The study found very low rates in all systems studied.)
Infections seem to intensify in regions of the world that lack adequate sanitation. In a study of free-range pigs in Mozambique, the authors concluded that "free range pig management system represented by far the most important risk factor for porcine cysticercosis"?a disease caused by a tapeworm larva. In Nigeria, pigs "reared by intensive system" had lower rates of bacterial infection than "the population of local pigs on free range." (Click here for a PDF of the study.)
Poultry has come in for its share of critical analysis as well, at least in the trenches of academic science. A study of Salmonella and free-range (and certified organic) chickens found that 31 percent of the 135 chickens sampled tested positive for the deadly bacteria. The authors were moved to warn that "Consumers should not assume that free-range or organic conditions will have anything to do with the Salmonella status of the chicken" (PDF). An investigation of Taxoplasma gondii (a parasite potentially fatal to fetuses) and free-range chickens in China reported that free-range birds showed an infection rate of 34.7 percent. Caged chickens had an infection rate of 2.8 percent. A similar study undertaken by the USDA's Agricultural Research Service reported that "A very high prevalence of the parasite (Taxoplasma gondii) was found in chickens raised in backyards (up to 100 %) and free range organic (30-50%) establishments." It further noted that "overall, prevalence of viable T. gondii in chickens raised indoors was low" (PDF). Swedish veterinary scientists had their findings summarized by a medical news outlet with this headline: "Free Range Chickens are More Prone to Disease."
Although these studies gained virtually zero media attention, not everyone has ignored their implications. The Humane Society of the United States?an organization fiercely dedicated to issues of animal welfare?put out a report in 2009 acknowledging the many virtues of a well-managed free-range operation. At the same, though, the report frankly admitted that "outdoor flocks may be exposed to wild birds, insects, and other potential infectious agents, and may come into contact with bacteria and intestinal parasites." It wrote that "Pollorum disease, a type of Salmonella infection, is currently rare in commercially raised chickens, but may occur in backyard flocks." And it even mentioned that "caged hens are generally protected (from the intestinal parasite Coccidia) by separation from their fecal material."
It's time concerned consumers take a page from the Humane Society and look squarely at the research. The idea of a free-range animal is appealing in so many ways. The animals are almost certainly happier. They are also removed from the battery rounds of antibiotics and vaccines that keep them growing in caged systems. They allow consumers to feel better about eating meat. But, as these very recent studies all suggest in one way or another, free-range?however it ultimately stacks up against confined methods?comes with its fair share of problems.

Salmonella, Campylobacter poultry standards set, May 11, 2010
by Bryan Salvage
WASHINGTON ? New performance standards to reduce Salmonella and Campylobacter in young chickens (broilers) and turkeys were announced on May 10 by Agriculture Secretary Tom Vilsack, which he said fulfills another key recommendation of the President's Food Safety Working Group.
Two compliance guides were also released by the U.S. Department of Agriculture's Food Safety and Inspection Service (F.S.I.S.). One is designed to help the poultry industry address Salmonella and Campylobacter and one compliance guide focuses on known practices for pre-harvest management to reduce E. coli O157:H7 contamination in cattle.
F.S.I.S. estimates that after two years, 39,000 illnesses will be avoided per year under the new Campylobacter standards and 26,000 fewer illnesses each year will be realized under the revised Salmonella standards.
F.S.I.S. announced these are the first-ever standards for Campylobacter, and mark the first revision to the Salmonella standards for chicken since 1996 and for turkeys since the first standards were set in 2005. The performance standards set a level in percentage of samples testing positive for a given pathogen an establishment must achieve and play a key role in reducing the prevalence of foodborne pathogens and preventing harm to consumers.
The President's Food Safety Working Group has set a goal of having 90% of all poultry establishments meeting the revised Salmonella standard by the end of 2010.
F.S.I.S. is seeking comment on the performance standards and two compliance guides announced in the Federal Register Notice. F.S.I.S. expects to begin using the standards after analyzing the comments and, if necessary, making any adjustments.
Comments regarding the compliance guides document must be received within the 60-day comment period through the Federal eRulemaking Portal at, or by mail to: Docket Clerk, U.S. Department of Agriculture, Food Safety and Inspection Service, Room 2-2127, George Washington Carver Center, 5601 Sunnyside Avenue, Mailstop 5474, Beltsville, MD 20705-5474. All submissions received through the Federal eRulemaking Portal or by mail must reference the Food Safety and Inspection Service and include the docket number "FSIS-2009-0034."

'Team Diarrhea' Funding Jeopardized
by Drew Falkenstein | May 11, 2010

Last week, in the wake of the State Supreme Court's ruling in Brayton et al. v. Pawlenty et al., Minnesota Governor Tim Pawlenty issued Executive Order 10-07, which seeks to prioritize core government functions in anticipation of shutting down non-core government functions to save money for the state's significant budget deficits.
The detection of communicable diseases like E. coli, Salmonella, and Campylobacter are within the purview of the Minnesota Departments of Health and Agriculture, which includes the nation's most dynamic and competent illness detection unit: "Team Diarrhea." This critical group of illness sleuths, in conjunction with the state's public health lab, are not only involved in, but are instrumental to, the detection of many outbreaks of not only state, but also national scope. Thus, in the wake of endless food poisoning outbreaks and recalls, the price of Governor Pawlenty's anticipated shutdown of any aspect of Minnesota's public health machine may be millions of dollars in medical costs, many illnesses, and maybe even worse.
On March 6, 2009, Elizabeth Weise and Julie Schmit profiled Team Diarrhea in a USA Today article titled, "When Food Illnesses Spread, Minnesota Team Gets the Call." The article details Team Diarrhea's role in cracking the national Salmonella Typhimurium outbreak linked to peanut products sold by Peanut Corporation of America. The outbreak ultimately caused nearly one thousand confirmed illnesses, nine deaths, and probably tens of thousands of other related illnesses. USA Today reported:
"Minnesota's prowess in investigating food-borne illness outbreaks--in contrast to less successful efforts by other states--exposes weaknesses in the nation's ability to quickly track and contain outbreaks, food safety specialists say.
"That's because the national system for identifying food-borne illnesses relies on the efforts of hundreds of local, regional and state health departments, all with differing capabilities, budgets, priorities and procedures. If an outbreak starts in a region ill-prepared to investigate cases, it may not be stopped as quickly as if it had started elsewhere, food safety officials say."
Just how many people were spared the agony and cost of severe illness as a result of Team Diarrhea's actions will never be known for sure, but the answer may well be measured in the thousands, in terms of illnesses prevented, and millions, in terms of medical costs saved. The article went on to state:
"Minnesota's fast work has protected the public from contaminated food before. Last year, its team was among the first to blame hot peppers--not tomatoes, the initial suspect--for the largest [S]almonella outbreak in a decade. In 2007, the team found pot pies to be the source of another [S]almonella outbreak. In both cases, Minnesota took less than a month to find what turned out to be a confirmed culprit when people had been falling ill in other states for months.
"When it comes to food-borne illness investigation, 'Minnesota is leap years ahead of ... most of the rest of the nation,' says James Phillips, head of infectious diseases for the Arkansas Department of Health."
Notably, part of Minnesota's success in stopping outbreaks cold is the regulatory and legal framework that the State of Minnesota has wisely put in place. By law, hospital laboratories in Minnesota are required to send stool samples that test positive for many communicable diseases on to the State Public Health Lab, which continues the detective work by identifying the strain and DNA fingerprint of the particular type of bacteria involved. This is critical in the detection of outbreaks because, for the most part, only illnesses from genetically related strains of bacteria indicate an ongoing outbreak.
In contrast, the same cannot be said for approximately 40 percent of other states. In the above-referenced article, USA Today reported, for example, that Texas, which had more than one-third of all illnesses in the pepper Salmonella outbreak, does not require hospital and clinic labs to send positive samples on to the state lab for further DNA and strain identification. "Instead, Texas only requests that labs send samples to the state lab, and they're not always sent."
The list of Minnesota's successes in major public health events and outbreaks is long and distinguished, and the cost of shutting the machine down may be, with no exaggeration, illness and death--and devastating losses to food businesses who are undoubtedly well-served by Minnesota's competent work. Just ask the tomato industry, which lost more than $100 million due to its erroneous association with the 2008 Salmonella saintpaul outbreak. Who knows how many more tomato farmers would have unnecessarily lost their livelihoods without Minnesota's help.
And one more statistic to support the argument that a shutdown of Minnesota's public health machine poses extreme risks to the entire country's health and well-being. Texas is one of the largest states in the country, with 22 million people. In 2006, Texas reported a grand total of 4 food poisoning outbreaks to the CDC. Wyoming, whose population totals half a million, also reported 4. Minnesota, with less than one-fourth the population of Texas, reported 79.
Nobody can fault Governor Pawlenty for trying to save money, particularly in this economic climate. But, speaking for the entire nation and all its residents who are undoubtedly served by the Minnesota health machine remaining in place and fully operational, we ask that you consider the grave threat to public health that closing the machine down would cause.

How Did E. coli O145 Contaminate Lettuce?
by Zach Mallove | May 12, 2010

A look at how E. coli O145 could have contaminated romaine lettuce on a farm in Yuma
As state and federal public health officials continue to investigate the E. coli O145 outbreak tied to bagged Freshway Foods romaine lettuce, which has sickened 19 in 3 states, many questions remain.
The supply chain from the field to the supermarket is a long one, with many potential points along the way for contamination to occur. Where did the lettuce pick up E. coli O145, a pathogen found primarily in cattle and wildlife feces? According to the latest out of the U.S. Food and Drug Administration (FDA), investigators are focusing on an undisclosed farm in Yuma, Arizona which could be linked to the outbreak.--If the contamination did occur on the farm, how could it have happened?
Unlike Salinas Valley, America's salad bowl, which has been the source of several E. coli outbreaks, including the Dole spinach outbreak in 2006 (pdf), Yuma-grown leafy greens have never been implicated.
Food Safety News paid a visit to the Yuma area and talked with epidemiological experts to explore a number of hypotheses. This series will look at three ways the E. coli O145-contaminated lettuce--if it was grown in Yuma--could have picked up the bug. Part I will explore dust and mud contamination, Part II will look at wildlife intrusions, and Part III will discuss irrigation water.
Part I - Dust, Mud, and E. coli
One of the largest cattle feedlots in the country is found in Wellton, AZ, around 20 miles, as the crow flies, from the heart of leafy green production in the Gila and Dome Valleys near Yuma. Naturally, the high concentration of cattle and manure produces a fecal, muddy mix in which E. coli bacteria can thrive. In a dry, windy environment like Yuma, mud-turned-dust can carry E. coli.
Most food safety experts agree that dust is a prime suspect in pathogenic produce contamination.
A study conducted in 2002 by researchers at Texas Tech University found that some common feeding practices were leading to a higher likelihood of dust-borne bacteria.
"A standard feeding practice in some western feedlots is to feed at sunrise. This protocol results in cattle that have digested their food by the evening, which coincides with the active, dust-generating period," the study discovered, leading the researchers to conclude that "airborne transmission could be a primary route of infection."
History supports the dust-borne hypothesis.
In September 2001, Ohio health officials identified a cluster of E. coli O157 infections at a fair in Lorain County, Ohio. A series of studies linked the outbreak to a large, open building that was used throughout the fair for animal shows. The building's floor was covered with sawdust, and on the last night of the fair, a large dance was held in the same building. Investigators concluded that an animal from an earlier show, most likely a cow, defecated on the ground, and the sawdust kicked up by other animals and humans contaminated nearly the entire building.
One report found this: "E. coli O157 survived and possibly multiplied in the sawdust. The sawdust may have become airborne during a large event such as the dance. Individuals who touched contaminated surfaces in the building became infected when they ate or drank without adequately washing their hands. It is possible that some may have swallowed bacteria that landed directly into their mouths or onto their food or drink."
Again, one year later, air-borne E. coli was cited as the probable origin of an outbreak.
In 2002, an outbreak of E. coli O157:H7 sickened 82 people at an Oregon county fair, the largest E. coli outbreak in Oregon state history. Although not confirmed, health officials postulated that possible exposures leading to the outbreak occurred at animal enclosures, including the cattle tent, horse barn, and exposition halls that housed goats, sheep, rabbits, chickens, ducks, and guinea pigs.
Investigators eventually traced the transmission path of the E. coli O157:H7 bacteria to pipes 15 feet above goat pens in a fair exhibition hall, where about 75 people, including 12 children, were believed to have been infected, leading them to believe the toxins were spread through the air.
Judging from these examples, it is clear how fecal bacteria from a cattle farm's manure pit could spread from feedlot to produce farm, especially in a dusty, highly windy environment like that of Yuma.
However, Michele Jay-Russell, a veterinarian and food safety specialist with the Western Institute for Food Safety and Security at the University of California, Davis, sounded doubtful about air-borne transmission in the Freshway E. coli O145 outbreak, citing the distance between feedlots and produce farms as a potential barrier.
"With that distance, it would be a stretch biologically," she said. "It would probably be more than just wind." Instead, she mentioned vehicles and clothing as possible carriers.
"But," she added, "It's certainly on the list of possibilities."
Helena Bottemiller co-wrote and contributed to the research for this article.

FDA Tries to Catch Up on Food Safety
Rebecca Voelker
JAMA. 2010;303(18):1797.
When she presented her agency's proposed budget to a US Senate subcommittee in early March, US Food and Drug Administration (FDA) Commissioner Margaret Hamburg, MD, described an ambitious food safety agenda. Hundreds of new personnel, including 132 food inspectors who would conduct 1900 domestic food safety inspections and 150 foreign food inspections annually, are part of the plan.

If approved, the price tag for the FDA's food safety programs for the next fiscal year would rise to $1.4 billion, an increase of $326 million from the previous year. More than one-quarter of the FDA's total $4 billion proposed budget would go toward food oversight. Hamburg told the senators that the increased funding is "laying the foundation for a shift to a food safety approach focused on prevention."
Experts say the funding boost and a focus on prevention are long overdue. "The FDA is catching up with absolutely deplorable Congressional appropriations, until about 3 years ago," said Peter Hutt, LLM, senior counsel of the Washington, DC, law firm of Covington & Burling and former FDA general counsel. "What we're seeing is the beginning to get back to where the FDA used to be in food safety."
From spinach to peanut butter, from jalapeno peppers to peppered salami, contaminated foods cause an estimated 76 million cases of disease and 5000 deaths each year in the United States, according to the Centers for Disease Control and Prevention (CDC). Even though the incidence of foodborne illnesses has remained relatively stable in recent years, the lack of progress in combating them has sounded alarms.
A 2008 report from the US Government Accountability Office (GAO), the independent agency that investigates government spending at the request of Congress, took the FDA to task for lengthy delays in implementing measures that could improve the safety of fresh produce. Another GAO report earlier this year focused on the FDA's deficiencies in properly monitoring food additives such as spices and preservatives. In March, a report sponsored by the Produce Safety Project at Georgetown University, in Washington, DC, estimated the cost of foodborne illness in the United States at $152 billion annually.
The Obama administration has responded to what Hutt and others describe as a crisis at the FDA with a sweeping Transforming Food Safety Initiative. In addition to adding inspectors and other staff, the initiative aims to set new food safety standards, establish methods of evaluating food safety systems in other countries, expand surveillance of seafood and animal feed, and develop regulations that enable rapid tracing of contaminated food but are not overly burdensome to industry. (The FDA did not respond to requests for an agency expert to provide further details.)
"Their priorities should be science- and risk-based, and be truly comprehensive from farm to table," said Catherine Adams, PhD, RD, principal in RdR Solutions Consulting in Washington, DC, and a former assistant administrator at the US Department of Agriculture's Food Safety Inspection Service.
Others say that industry accountability rather than more regulation is key to creating a safer food supply. "If you make industry pay the price for the illnesses that they cause, they're likely to change. They know better than anyone where the problems are in their process," said Robert Scharff, PhD, assistant professor of consumer sciences at the Ohio State University, in Columbus, and former FDA economist who wrote the Produce Safety Project report.
Scharff said responsible food manufacturers, in an effort to protect their own reputations and avoid lost sales or lawsuits because of a foodborne illness outbreak, are beginning to require their suppliers to identify the source of foods. A new technology that has attracted food manufacturers' interest is radio-frequency identification tags?tiny transmitters that can be scanned each time foods reach a new point in the supply system. "That way, they have an electronic record of where [foods] have been," Scharff noted.
"My worry is that the FDA will use the old way of regulating foods, and just do more of it," he added. "Technology has made it easier to go in a different direction, which is the direction of really trying to hold industry accountable."

E. coli Lawsuit Filed Against Lettuce Supplier
by Suzanne Schreck | May 12, 2010

An E. coli lawsuit was filed yesterday against Freshway Foods, the company that recalled its romaine lettuce products after they were identified as the source of an E. coli O145 outbreak among students at The Ohio State University, the University of Michigan, and Daemon College in Buffalo, New York last month.
In the lawsuit filed by Seattle-based Marler Clark, attorneys allege the Columbus, Ohio, resident the firm represents became ill with an E. coli O145 infection after eating contaminated lettuce distributed by Freshway Foods.
The lawsuit names Freshway Foods as well as the grower and distributors of the contaminated lettuce as defendants.
The Freshway Foods E. coli Outbreak
According to the Centers for Disease Control and Prevention (CDC), at least 19 people who consumed Freshway Foods romaine lettuce have tested positive for E. coli O145. Test results for samples collected from ten additional probable E. coli O145 cases are not yet available; it takes an average of 2 to 3 weeks from the time a person becomes ill to the time when the illness is confirmed by laboratory testing and reported.
Patients interviewed by health department investigators reported becoming ill between April 10 and April 26. Twelve were hospitalized, three with hemolytic uremic syndrome, or HUS--a syndrome that results in hemolytic anemia (destruction of red blood cells), thrombocytopenia (low platelet count), and acute kidney failure.
In a press release, Freshway Foods said the E. coli O145-contaminated romaine lettuce was sold to wholesalers, food service outlets, in-store salad bars, and delis in Alabama, Connecticut, the District of Columbia, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, West Virginia, and Wisconsin. The affected lettuce has a "best if used by" date of May 12 or earlier. Freshway Foods has recalled all implicated product.
E. coli O145
E. coli O145 bacteria are Shiga toxin-producing E. coli, or STEC. Shiga toxin is one of the most potent toxins known to man, so much so that the CDC lists it as a potential bioterrorist agent.
The STEC serotype most commonly found in U.S. patients is E. coli O157. Other E. coli serotypes in the STEC group, including O145, are sometimes called "non-O157 STECs." Currently, there are limited public health surveillance data on the occurrence of non-O157 STECs, including O145 since many public health labs do not test for non-O157 STECs.
More Lettuce Recalled for E. coli
In the wake of the Freshway Foods E. coli O145 outbreak in romaine lettuce, some affected states began widespread testing of romaine samples. A laboratory in Ohio found another strain of E. coli which led to a very private recall on Friday by Andrew Smith Co. A spokeswoman for Andrew Smith Co. in Spreckels, Calif., said none of the lettuce was sold in grocery stores and that only two food processors bought the cartons. Health officials determined that the two E. coli O145 recalls are unrelated.

How Did E. coli O145 Contaminate Lettuce? Part II
by Helena Bottemiller | May 13, 2010

A look at how E. coli O145 could have contaminated romaine lettuce on a farm in Yuma - Part II
As state and federal public health officials continue to investigate the E. coli O145 outbreak tied to bagged Freshway Foods romaine lettuce, which has sickened 19 in 3 states, many questions remain.
The supply chain from the field to the supermarket is a long one, with many potential points along the way for contamination to occur. Where did the lettuce pick up E. coli O145, a pathogen found primarily in cattle and wildlife feces? According to the latest out of the U.S. Food and Drug Administration (FDA), investigators are focusing on an undisclosed farm in Yuma, Arizona which could be linked to the outbreak. If the contamination did occur on the farm, how could it have happened?
Unlike Salinas Valley, America's salad bowl, which has been the source of several E. coli outbreaks, including the Dole spinach outbreak in 2006, Yuma-grown leafy greens have never been implicated.
Food Safety News paid a visit to the Yuma area and talked with epidemiological experts to explore a number of hypotheses. This series will look at three ways the E. coli O145-contaminated lettuce--if it was grown in Yuma--could have picked up the bug. Yesterday, Part I explored dust and mud as possible modes of contamination. Today Part II looks at wildlife intrusions, and tomorrow Part III will discuss irrigation water.
Part II - Wildlife Intrusions
As we noted yesterday, one of the largest cattle feedlots in the country is located in Wellton, AZ, around 20 miles, as the crow flies, from the heart of leafy green production in the Gila and Dome Valleys near Yuma. Naturally, the high concentration of cattle and manure produces a fecal, muddy mix in which E. coli bacteria can thrive. That mud, or mud-turned dust, could be picked up by birds or other animals stopping through the area.
With the exception of migratory birds and desert rodents, Yuma has very few wild animals that could venture onto leafy green farmland carrying E. coli bacteria. There are no forests in close proximity to the fields, unlike the Salinas Valley, where feral swine and other wildlife could excrete or externally carry E. coli onto a greens field. The large, multistate E. coli spinach outbreak in 2006 linked to Salinas is thought to have been caused by a wildlife intrusion, possibly by a feral pig, but a mode of transmission was never found.
"The role of wildlife as a source of foodborne microbial contamination along the farm-to-fork continuum is a long-standing concern among public health and food safety agencies," according to a 2008 report by Edward Atwill at the Western Institute for Food Safety and Security at the University of California at Davis. "[The 2006 spinach outbreak] heightened concerns about the ability of wildlife to forage within or to transit through the produce production environment, and what biosecurity measures are in place to prevent wildlife access to foods that are minimally processed and often consumed raw."
Wild birds, in particular, are considered potential vehicles for carrying pathogens from farm to farm. A study conducted by Canadian researchers in 2001 found indistinguishable E. coli O157 subtypes at two different feedlots approximately 100 km apart, determining that wild birds were among the only potential common vehicles shared between the two feedlots.
Another study performed by Ohio State University researchers in 2008 yielded similar results.
"The patterns of bird movement . . . along with the isolation of the pathogen E. coli O157 from both birds and cattle, further support the hypothesis that birds play a critical role in the dissemination of important foodborne bacteria among farms."
When Food Safety News visited Yuma, we were struck by how many birds there were. It was easy to imagine the possibility of birds playing a role in contamination in a lettuce field (All leafy greens commercially grown in Yuma have been harvested, production has moved back to Salinas).
"It's one of the things we're concerned about," says Arnott Duncan, a grower who serves on the Arizona Leafy Greens Marketing Agreement committee. "But we aren't going to be shooting the birds. There are a number of ways greens could become contaminated."
Zach Mallove co-wrote and contributed to the research for this article.

New Web Site Provides Factual Look at "Raw-Milk"
Posted on May 13, 2010 by David Babcock

A group of food-safety advocates from a broad spectrum of backgrounds has launched to provide potential consumers with information about unpasteurized milk. The website draws contributions from "Scientists, food safety advocates and health educators from universities, government, industry, and professional organizations."
There have been numerous media reports lately of the growing popularity of raw milk. Also growing has been the debate over the true risks and benefits associated with the product. The website is designed to address that controversy:
While on the surface raw milk might sound like a healthy alternative to the commercial product, the pasteurization process was developed to eradicate potentially deadly pathogens such as E. coli 0157:H7, Salmonella, and Campylobacter, which can be transferred into milk from the animal and farm surroundings.
The site is also designed to provide updated coverage of raw-milk issues, including contamination outbreaks and related recalls.

AMI Defends Current E. coli Tracing Procedures in Comments to FSIS
Thursday, May 13, 2010

(American Meat Institute)
AMI is unaware of any data that would support the need to change current policy regarding follow-up sampling and inspection methods except in the case of high event periods, says AMI Vice President of Food Safety and Inspection Services Scott Goltry in comments submitted to the Food Safety and Inspection Service (FSIS) on the issue of tracing procedures for E. coli O157:H7.
Goltry¡¯s comments reiterate much of what he stated during a recent public meeting to discuss FSIS¡¯ product tracing efforts.
¡°As previously stated in comments to the agency, AMI agrees that each establishment should develop or continue to use process control procedures that are based on findings, corrections and possible changes in production or disposition and react appropriately when there are higher than normal positive tests. AMI contends, however, that a set, predetermined number of positive test results defines a high event period for an establishment, as previously mentioned by FSIS, is without basis in science and fact,¡± AMI states.
AMI notes that in 2009, there were 35 federal ground beef verification positives, which resulted in 492 ground beef and 940 raw ground beef component follow-up samples. Thus, there were 40.9 follow-up samples taken for each ground beef positive, evidence that existing E. coli O157:H7 tracing measures are effective.
The agency also calculates the percent of E. coli O157:H7 basis using a volume weighted method for verification samples. This metric takes into consideration the production volume as a risk factor. Using this calculation shows the difference in the percent positive rate was much higher is 2005 (0.5 percent) but shows an improvement to 0.26% in 2009.
In the comments, the Institute encourages the agency to adopt or support the control of product pending lab analysis. FSIS has taken under consideration a petition by AMI that the agency implement a system whereby product tested by the agency must be controlled by the company until the result is known.
AMI notes that it supports representative sampling of ground beef by FSIS. Furthermore, AMI encourages the agency to review ground beef production practices and sample ground beef products that are routinely produced by the processing facility instead of, for instance, a processor grinding a primal, or coarse ground beef, when those products are not routinely used by the business to produce ground beef.
AMI also stresses the importance of investigations being completed in a quick and timely manner.
¡°Because of the potential for illnesses, this investigation, especially of a single occurrence, should be expected to be completed in a day,¡± the comments state.
To view AMI¡¯s submitted comments, click here: The link to this document is:

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